Clinical and Pathological Characteristics of Patients Presenting with Biochemical Progression after Radical Retropubic Prostatectomy for Pathologically Organ-Confined Prostate Cancer

Abstract

Introduction: To identify risk factors for biochemical failure after radical prostatectomy (RP) in men with pathologically organ-confined (OC) prostate cancer (PCa). Materials and Methods: Clinical and pathological features of 350 consecutive patients with pathologically OC PCa treated only with RP and bilateral pelvic lymphadenectomy were analyzed, retrospectively, to identify predictor parameters of prostate-specific antigen (PSA) failure (PSA ≧0.4 ng/ml). The median follow-up was 58.6 months (range: 3.9–183 months). All pathological specimens were step sectioned at 4-mm intervals. Kaplan-Meier progression-free survival rates and χ² test were adopted for statistical analyses. Multivariate Cox proportional hazard regression models were used to test the association between pathological Gleason score and surgical margin status. Results: 67 patients (19.1%) failed at a median follow-up of 40.2 months (range 1.9–123.3). Age and preoperative PSA failed to reveal significance also in patients with serum PSA ≧20 ng/ml (p = 0.46). Patients with T3 clinical stage had a higher progression rate compared to T1C and T2 (43.5 vs. 27.8 and 17.3%, respectively) even if no high statistical significance was pointed out. Presence of perineural infiltration (p = 0.04) and prostatic apex infiltration (p = 0.74) in the prostatectomy specimens failed to reveal significance. A high pathological Gleason score (≧7; p = 0.0003) and surgical margin status (p < 0.0001) were shown to be the most powerful predictive parameters of biochemical progression. Conclusions: In patients with pathologically OC PCa the presence of a high pathological Gleason score and positive surgical margins appear to represent the most important factors for prediction of outcome following RP.

Adjuvant Radiotherapy after Radical Prostatectomy: Indications, Results and Side Effects

“…Although some authors saw no independent prognostic factor for bNED (no biochemical evidence of disease), in other studies the positive apical margin with pT2 carcinomas was identified as being an independent prognostic factor [5,11] . There are no randomized studies comparing 'wait and see' and adjuvant radiotherapy.…”

“…While for tumor stage pT2 the meaning of the positive margins is controversial, it is indisputable that in tumor stage pT3 positive margins represent an independent risk for biochemical progression [5][6][7] . According to this positive margin, it seems reasonable to suppose that the remaining microscopic tumor is usually obvious at the height of the anastomosis region, but also in the resection bed of the prostate.…”

“…In approximately 20% of the cases this is clinical overstaging [4] . The positive margin after radical prostatectomy is of substantial prognostic importance [5] . While this is rare in stage pT2, for pT3 tumors it is common also in hospitals with a high surgical volume.…”

How localized is pathologically localized prostate cancer? The use of secondary circulating prostate cells as a marker of minimal residual disease and their association with patient outcome

“…Failure of RP in these patients is not easily understood, and has been reported to occur in 5-23% of the patients. [4][5][6] In patients who achieve PSA nadir of 0.01 ng/mL post-surgery, as in our series, it is even harder to explain failure of RP. Although an erroneous pathological classification may, in terms of either the cancer penetrating the PCa (pT3) or an anatomically incorrect dissection plane (unrevealed positive margin), which left behind microscopic amounts of PCa and then subsequently progressed, explain some cases but not the majority.…”

“…[1,2] Although the percentage of patients with pathologically organ-confined tumors has substantially increased [3] , 4-32% of these men will eventually relapse following radical prostatectomy (RP). [4][5][6] Multivariate analyses have reportedly revealed that the pathological tumor grade (Gleason score) and preoperative serum PSA are highly predictive of outcome following RP for pathologically localized PCa. [7] More recently, it has been reported than even men with high grade Gleason scores of 8-10 have long-term outcomes similar to those men with more favorable disease characteristics when the disease is pathologically organ confined.…”